MEDICARE: JAMES H PENNINGTON OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	18001491A	IN

General Provider Information

NPI Number	:	1841436532
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES H PENNINGTON OD

Provider Business Mailing Address
First Line	:	6421 GEORGETOWN NORTH BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-7007
Country	:	US
Telephone Number	:	260-485-6211
Fax Number	:	260-492-0741

Provider Business Practice Location Address
First Line	:	6421 GEORGETOWN NORTH BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-7007
Country	:	US
Telephone Number	:	260-485-6211
Fax Number	:	260-492-0741

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JAMES H PENNINGTON
Credential	:	OD
Telephone Number	:	260-485-6211

Provider Enumeration Date	:	12/30/2008
Last Update Date	:	12/30/2008

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